Objective To investigate the localization accuracy and clinical effect of neuronavigation-guided stereotactic electroencephalogram （SEEG） in insular epilepsy.Methods A total of 218 patients with medically intractable epilepsy underwent neuronavigation-guided SEEG in our hospital from January 2015 to January 2019， and electroencephalography monitoring of the ictal period showed that 12 patients had epilepsy originating from the insula.Results All 12 patients received the implantation of 10~16 depth electrodes， and postoperative reconstruction showed the accurate position of the electrodes. No hematoma or infection was observed. Postoperative monitoring detected 3~20 epileptic seizures in all patients， and after accurate localization， 10 patients underwent craniotomy and 2 patients were treated with radiofrequency thermocoagulation. After treatment， 1 patient experienced early speech impairment and 1 experienced hemiplegia， and the 2 patients returned to normal after treatment. Postoperative assessment showed grade I Engle score in 8 patients， grade II Engle score in 3 patients， and grade III Engle score in 1 patient.Conclusions Insular epilepsy has various forms of seizures and is difficult to localize. Neuronavigation-guided SEEG can improve localization accuracy rate and achieve a reliable treatment outcome after surgery.